Healthcare Provider Details

I. General information

NPI: 1437563657
Provider Name (Legal Business Name): RAJ KIRAN CHAWLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 S 103RD ST STE 210
MILWAUKEE WI
53227-4161
US

IV. Provider business mailing address

9000 W WISCONSIN AVE # MS 958
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 262-814-7080
  • Fax: 262-432-9004
Mailing address:
  • Phone: 414-266-7451
  • Fax: 414-266-6238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10050944
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number67325
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: